Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

Guardian Angels Hospice LLC | 480-565-7558 | info@guardianangelshospiceaz.com

Effective Date: September 30, 2026

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

• Get an electronic or paper copy of your medical record and other health information we maintain about you.
• Ask us to correct health information you believe is incorrect or incomplete.
• Request confidential communications, such as asking us to contact you at a specific number or address.
• Ask us to limit certain uses or disclosures of your information.
• Receive an accounting of certain disclosures of your health information.
• Get a paper copy of this notice at any time.
• Choose a personal representative who is legally authorized to act for you.
• File a complaint if you believe your privacy rights have been violated.

Your Choices

For certain health information, you may tell us your preferences about what we share. When you are able to tell us your preference, we will follow your instructions as permitted by law.

• Share information with family members, close friends, caregivers, or others involved in your care or payment for your care.
• Share information in a disaster relief situation.
• Receive fundraising communications. If we contact you for fundraising, you may tell us not to contact you again.

If you are unable to tell us your preference, we may share information when permitted by law and when we reasonably believe the disclosure is in your best interest or is needed to lessen a serious and imminent threat to health or safety.

Uses That Generally Require Your Written Authorization

• Most uses or disclosures for marketing purposes.
• The sale of your protected health information.
• Most uses or disclosures of psychotherapy notes, when applicable.
• Other uses or disclosures not otherwise permitted or required by law.

If you give us written authorization, you may revoke it in writing at any time, except to the extent we have already acted in reliance on it.

How We Typically Use or Share Your Health Information

Treat you

We may use and share your health information with physicians, nurses, social workers, chaplains, aides, pharmacists, pharmacies, laboratories, durable medical equipment suppliers, facilities, hospitals, and other professionals involved in your care. For example, we may share information with your attending physician or assisted living facility to coordinate symptom management and your hospice plan of care.

Run our organization

We may use and share your information to operate Guardian Angels Hospice, improve quality, coordinate services, train staff, conduct compliance activities, and contact you or your representative when necessary.

Bill for services

We may use and share your information to bill and obtain payment from Medicare, Medicaid, health plans, or other responsible payers, as permitted by law.

Other Uses and Disclosures Permitted or Required by Law

We may use or share your health information for other purposes permitted or required by law. These disclosures are subject to applicable legal conditions and safeguards.

• Public health and safety activities, such as disease prevention, reporting certain adverse events, reporting suspected abuse or neglect, or preventing a serious threat to health or safety.
• Health research when legal requirements are met.
• Compliance with federal, state, or local law, including disclosures to the U.S. Department of Health and Human Services for privacy compliance reviews.
• Organ and tissue donation requests.
• Coroners, medical examiners, and funeral directors when an individual dies.
• Workers' compensation, health oversight, law enforcement, and other government requests when permitted by law.
• Court or administrative proceedings, including responses to qualifying court orders, subpoenas, or other lawful process.

Special Privacy Protections

When another federal or Arizona law provides greater privacy protection than HIPAA, we will follow the more protective law. Additional protections may apply to certain behavioral health information, communicable disease information, genetic information, and substance use disorder records.

To the extent we create, receive, or maintain records protected by 42 CFR Part 2, those records receive additional federal confidentiality protections. We generally may not use or disclose Part 2 records in civil, criminal, administrative, or legislative proceedings against you unless you provide written consent or the disclosure is supported by a qualifying court order and subpoena as required by federal law.

Your Rights in More Detail

Get a copy of your record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information we have about you. We will generally provide a copy or summary within 30 days. We may charge a reasonable, cost-based fee when permitted by law.

Ask us to correct your record

You may ask us to correct information you believe is incorrect or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing, generally within 60 days.

Request confidential communications

You may ask us to contact you in a specific way or at a different address. We will accommodate reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not always required to agree. If you pay for a service or health care item in full out of pocket, you may ask us not to share that information with your health plan for payment or health care operations unless a law requires the disclosure.

Get an accounting of disclosures

You may ask for a list of certain disclosures we made during the six years before your request. The list will not include every type of disclosure, such as many disclosures for treatment, payment, or health care operations. One accounting in a 12-month period is provided without charge; a reasonable cost-based fee may apply to additional requests.

Choose someone to act for you

If another person has legal authority to act for you, such as a health care power of attorney or legal guardian, that person may exercise your privacy rights. We will verify the person's authority before acting.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in the notice currently in effect and make a copy available to you.
• We will not use or share your information other than as described in this notice unless you authorize us in writing or the law otherwise permits or requires it.

Changes to This Notice

We may change the terms of this notice. Changes may apply to all health information we maintain, including information created or received before the change. A revised notice will be available upon request, in our office, and on our website.

Complaints and Questions

You may complain to Guardian Angels Hospice if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

• By mail: 200 Independence Avenue, S.W., Washington, D.C. 20201
• By phone: 1-877-696-6775
• Online: through the HHS Office for Civil Rights complaint process

Privacy Contact

Privacy Officer, Guardian Angels Hospice LLC

1901 E University Dr, Suite 330CMesa, AZ 85203-8310

Phone: 480-565-7558

‍Fax: 480-565-7559

‍Email: info@guardianangelshospiceaz.com

‍Website: https://guardianangelshospiceaz.com